Complications are caused by the toxin released by the diphtheria bacteria and include upper airway obstruction, pneumonia, heart failure, and paralysis.

Fever and irritability occur less commonly

Generalized rigidity and convulsive spasms of skeletal muscles.

Severe spasms can cause fractures in the spine and long bones. Spasms in the larynx cause eating and breathing difficulties.

Lymphadenopathy and fever may occasionally occur

Serum sickness, brachial plexus neuropathy, encephalomyelitis, and transverse myelitis rarely reported

Risk of Guillain-Barre Syndrome (GBS) following immunization with a tetanus – containing vaccine is 0.4 per million doses of vaccine.

Complications include; Apnea, Pneumonia: 5.2%, Seizures: 0.8%, Encephalopathy: 0.1%

Local reactions (redness, swelling, and pain) increase with the number of doses received

Moderate to severe systemic events are reported rarely with acellular vaccines

Meningitis case fatality rate: 5% (10-15% of Hib meningitis survivors have permanent neurologic sequelae and 15-20% have deafness.)

Epiglottitis, pneumonia, septic arthritis, and cellulitis

Paralytic polio: 1% (25% of these will have post poliomyelitis syndrome)

Death: 5-10% in paralytic polio infections ( 2-5% in children and 15-30% in adults)

No severe adverse events reported with IPV

Pneumonia, otitis media: 10%

Thrombocytopenia:1/300 cases

Encephalitis: 0.1% (1/1000 cases) (case fatality: 15%; neurologic sequelae: 25%)

Death: 0.05-0.3% (1/3000 cases)

Subacute sclerosing panencephalitis: 1/25,000 cases

Malaise and fever, with or without a non-infectious rash: 5%

Parotitis: up to 1%

Swollen glands, stiff neck or joint pains: 5%

Transient arthralgia or arthritis more common in post-pubertal females (25% of post-pubertal females may experience arthralgia, and 10% may have arthritis-like signs and symptoms)

Encephalitis:1 case per million doses

Transient thrombocytopenia: 1 in 30,000 doses

Orchitis: 20-30% in post pubertal males

Oophoritis: 5% in post pubertal females

Deafness: 0.5-5.0 per 100,000 cases

Encephalitis: 0.5%

Encephalitis: 1/6,000 cases

Risk of Congenital Rubella Syndrome (CRS) is 85% in maternal infections in the first 10 weeks of pregnancy. CRS may include miscarriage, stillbirth, and fetal malformations such as congenital heart disease, cataracts, deafness, and mental retardation.

Risk of chronicity depends on age at time of infection: infants: 90-95%; children 1-5years: 30-50%; adults: 5%

Chronic carriers have an increased risk of hepatic cirrhosis and hepatocellular cancer (cause of up to 80% of hepatocellular carcinomas)

Fever (up to 37.7°C): 1% of adults and 0.4-6.4% of children

Mild systemic symptoms such as fatigue, headache, and irritability: 11-17% of adults and 0-20% of children

HPV types 6 and 11 cause 90% of genital warts

HPV causes 36% of oropharyngeal cancer; 24% of oral cancer, and 24% of laryngeal cancer

Recurrent respiratory papillomatosis caused by HPV types 6 and 11 may be acquired from mother at birth or occur in adulthood

Death reported in 0.5-1 per 1000 cases; most deaths in persons ≥ 65 years of age

During epidemics, there may be increased mortality and morbidity among the elderly, the immunocompromised and those with chronic disease

Fever: ≤ 12% of children 1-5 years of age

Headache, malaise, myalgia: <1%

Risk of GBS estimated to be 1 excess case per million doses of influenza vaccine

Meningitis case fatality: 5-10%.

Septicemia: 5-20% of cases

Pneumonia: 5-15% of cases

Arthritis: 2% of cases

Otitis media and epiglottitis: <1% of cases

Sequelae occur in up to 20% of survivors and include hearing loss, neurologic damage, loss of limbs from gangrene, and kidney damage.

Irritability: up to 80% of infants

Fever >39°C: up to 9% (when given at same time as other vaccines)

Headache and malaise: up to 10% of older children and adults

Severe reactions: < 0.01%

Risk of GBS associated with quadrivalent conjugate meningococcal vaccine continues to be monitored

Polysaccharide vaccines:

Local reactions (pain and redness): up to 50%
Fever: 5%, particularly in infants

Case fatality rate is 5-7% overall (much higher among the elderly)

Most common cause of bacterial meningitis. Case fatality rate is 30% (up to 80% among the elderly)

Bacteremia: case fatality rate is 20% (up to 60% among the elderly)

Otitis media

Local reactions (pain, swelling, or redness at injection site): 10-20%; Fever: 15-24% (when vaccine administered at the same time as whole cell pertussis vaccine)

Polysaccharide vaccine:

Local reactions: 30-50%

Fever: 2%

Irritability, drowsiness, restless sleep, decreased appetite, headache, malaise may occur with conjugate or polysaccharide vaccine

Low platelets: 1-2%

Cerebellar ataxia: 1/4000 cases

Encephalitis:1/5000 cases

Invasive group A Streptococcal infection: 5/100,000 cases

Death (per 100, 000 cases):

Adults: 30 deaths

Infants < 1year old: 7 deaths

Children 1-19 years old: 1-1.5 deaths

Otitis media, bacteremia, pneumonia, osteomyelitis, septic arthritis, endocarditis, necrotizing fasciitis, toxic shock-like syndrome

Reactivation of varicella virus as Herpes Zoster (shingles) later in life: 20%

Congenital varicella syndrome: up to 2% of fetuses born to mothers infected at 13-20 weeks gestation

Small number of generalized varicella-like papules or vesicles: 5% after the first dose and 1% after a second dose

Fever: 10-15%

Local reaction (pain, swelling, and redness at injection site): 10-20%

Risk of zoster after vaccination: 2.6/100,000 vaccine doses

No deaths or congenital varicella have been attributed to vaccine.